AFFIDAVIT OF RESTORATION FOR A SALVAGE MOTOR VEHICLE
State Form 44606 (R2 / 8-04)
INDIANA SALVAGE MOTOR VEHICLE RESTORATION AFFIDAVIT READ THE FOLLOWING BEFORE COMPLETING THIS AFFIDAVIT
1. Making false statements on this affidavit may constitute the CRIME OF PERJURY. 2. A person who knowingly possesses, buys, sells, exchanges, gives away, or offers to buy, sell, exchange, or give away a manufacturers vehicle identification number plate or serial plate that has been removed from a motor vehicle, motorcycle, semitrailer, or recreational vehicle that is a total loss or salvage commits a CLASS D FELONY. 3. A certificate of salvage title must be attached to this affidavit when making application for an Indiana REBUILT VEHICLE title. Salvage titles may be assigned by the owner of the salvage vehicle to another buyer. A business registered with the Bureau of Motor Vehicles may reassign a certificate of salvage title one (1) time without applying to the bureau for the issuance of a new certificate of salvage title. 4. A physical inspection by an INDIANA POLICE OFFICER is required before a REBUILT VEHICLE tile can be issued. The only police officer permitted to sign this form is an INDIANA POLICE OFFICER. Inspections performed by anyone else will not be accepted. 5. This form may accompany an out-of-state salvage title. A vehicle that has been designated JUNK, NON-REPAIRABLE, NONREBUILDABLE, SCRAP, NOT FOR HIGHWAY USE, or like similar designation, may not be titled in Indiana. RESTORER INFORMATION
Name of restorer Business name / dealer number (if applicable) Address (number and street, city, state, ZIP code) Year Make
Vehicle identification number Salvage title number attached to this form Date salvage vehcile acquired Price
$ PHOTO AND DESCRIPTION
PROVIDE A PHOTO AND DETAILED DESCRIPTION OF THE SALVAGE VEHICLE PRIOR TO RESTORATION.
RESTORATION STATEMENT 1. I have listed all major component parts incorporated during the restoration process on the reverse side. All receipts, bills of sale, or other ownership documents for these parts are attached. 2. IC 9-13-2-95 states that major component part is defined as those parts of motor vehicles, motorcycles, semitrailers, or recreational vehicles normally having a manufacturers vehicle identification number, a derivative of the identification number, or a number supplied by an authorized governmental agency, including doors, fenders, differentials, air bags, frames, transmissions, engines, doghouses (front assembly), rear clips, and additional parts described by the bureau. 3. I make this affidavit to document the restoration of the above described salvage motor vehicle and to induce the State of Indiana, Bureau of Motor Vehicles to, issue an Indiana REBUILT certificate of title in my name. 4. I swear and affirm that the information I have entered on this form is correct. I have accurately described damage and provided proof of purchase for the salvage vehicle and all major component parts used in the restoration. To my knowledge, no stolen parts were utilized in the restoration process. I UNDERSTAND THAT MAKING A FALSE STATEMENT ON THIS AFFIDAVIT MAY CONSTITUTE THE CRIME OF PERJURY.
Signature of restorer Signature of owner (if different from restorer) Date (month, day, year) Date (month, day, year)
(Continued on the reverse side)
NAME OF PART
(Example) Fender 1.
MAJOR COMPONENT PARTS LIST NAME AND ADDRESS OF SOURCE
ABC Salvage 123 West Main Greenwood, IN 46142
June 22, 1996
COST OF PART *
$250.00 (Receipt Attached)
(* RECEIPT, BILL-OF-SALE, OR OTHER OWNERSHIP DOCUMENTS MUST BE INCLUDED FOR EACH PART LISTED ABOVE. IF ADDITIONAL SPACE IS NEEDED TO LIST PARTS, ATTACH ADDITIONAL PAGES.) PHYSICIAL INSPECTION BY AN INDIANA POLICE OFFICER I hereby certify that I am a law enforcement officer of the state of Indiana and I have personally examined the following vehicle and checked the vehicle and component parts for theft status. This salvage restoration conforms to Indiana Code 9-22-3, Salvage Motor Vehicles. I have examined all receipts, bills-of-sale, other ownership documents, and attachments. Additionally, I have physically examined two of the following numbers. (One of the two must be VIN located on dash)
Public vehicle identification number: Federal inspection decal: Motor: Transmission:
OFFICER INFORMATION I understand that making a false statement on this affidavit may constitute the crime of perjury.
Printed name of officer Title ID number
Police department location
Signature of police officer
Date (month, day, year)
PERSON REQUESTING INSPECTION
Printed name of person requesting inspection
Business name and / or dealer number
Drivers license or state ID number